A note from Council Chair Ken Horton, RCS, RDCS, FASE: As 2011 comes to an end, I thought it a good time to look back at the advocacy issues the ASE has dealt with this year. It is important for sonographers to understand the importance of the work done by the Advocacy Committee, as changes made to legislation and reimbursement will have direct and significant impact on our profession, and this committee monitors these changes and works diligently to protect the interests of our members. I asked Sue Maisey and Elizabeth McIlwain, sonographers active on the Advocacy Committee, to summarize the year in advocacy.
Advocacy for our profession is changing quickly, and it is important that YOU take an active role. Stay informed, act when requested, and utilize the advocacy section of the ASE Website to stay abreast of the ever-changing landscape. Much of the work of the Advocacy Committee this year has related to sonographer licensure/credentialing and coding/reimbursement issues. Highlights include:
Sonographer Credentialing/Licensure Update
CARE Bill: The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Bill (CARE Bill) was re-introduced this year in the House of Representatives (HB 2104). Its passage would ensure that all medical imaging procedures (including cardiovascular ultrasound) would be performed by appropriately credentialed and trained individuals. Working with the Alliance for Quality Imaging and Radiation Therapy, the Advocacy Committee actively monitors this pending legislation, keeps members informed of the status and sends out action alerts to our members to further the passage of the CARE Bill in this legislative session.
State licensure: In 2011, licensure legislation was introduced in North Carolina and West Virginia. While these bills would have required licensure in both states, the language negatively impacted cardiovascular sonography. Action was taken to have the language changed in both states. When this was unsuccessful the ASE, working through the Sonography Licensure Coalition (SLC), successfully stopped the legislation in both states. It is anticipated that legislation will be reintroduced next year, and work is already underway to ensure that the language is appropriate to the unique needs of cardiovascular sonography.
Oregon and New Mexico are currently the only two states requiring licensure for sonography. Oregon’s bill is in effect and sonographers are required to be licensed. The New Mexico legislation, though passed into law, has not been implemented. In both states, nursing organizations have raised questions regarding point-of-care ultrasound. Steps are being taken to address these concerns and draft amendment language that meets the needs of sonographers, nurses, and most importantly our patients.
Coding/reimbursement update: The decline in reimbursement rates and rise in use of radiology benefit management companies continue to be a major focus for the Advocacy Committee. The ASE has worked tirelessly through the ACC and independently to represent our interests. Successes and ongoing activities include:
Successfully defeating the use of medical imaging cuts as offsets for the Trade Assistance Act.
Opposing McKesson’s claim edits that deny claims for echo interpretations performed on inpatients on the same date of service as an inpatient (E/M) visit. Some private payers are now requiring the use of modifier -25 to the E/M code or reporting modifier -59 with the diagnostic imaging tests. ASE is continuing to contest this new requirement and is working with the AMA to have a CPT editorial ruling issued.
Providing comments to CIGNA on its draft medical policy for transthoracic echocardiography (TTE). The payer announced plans to implement a new policy beginning July 1, 2011, to only reimburse for those indications that adhere to the Appropriate Use Criteria. Comments were primarily focused on including additional appropriate ICD-9 diagnosis codes for reimbursement. CIGNA is reviewing the comments.
Providing comments to CMS on the proposed 2012 HOPPS Rule which would reduce the reimbursement for the primary echocardiography CPT code used by hospitals, 93306, by approximately 5%. These comments noted that hospitals commonly misreported TTE with spectral and color Doppler by using the older code combination instead of the newer single combined code. It is felt that this error is causing the calculation of the relevant Ambulatory Payment Classification (APC) to be adversely affected.
Work continues on an APC for contrast-enhanced stress echocardiography (with stress test). The ASE maintains that this should be paid at a higher rate than comparable unenhanced studies. The ASE urges CMS to establish APC classifications that allow hospitals to recoup the additional cost of contrast and its administration when contrast-enhanced stress echo/stress studies are performed.
At the recent RUC meeting, ASE and the ACC defended the valuation of one of the primary codes for echocardiography: CPT code 93308: echocardiography, transthoracic follow-up, or limited study . ASE and ACC presented the data collected from the survey this summer. The presentation seemed to be well received and a final ruling is expected soon.
Hopefully this summary has answered some questions and piqued your interest. Remember, advocacy is not something done by a small group of people. There are times when it takes an army, and that army must include you!
Volunteer of the Month
This month’s sonographer volunteer is Karen Chin BS, RCS, a multimodality imaging specialist from Methodist DeBakey Heart & Vascular Center in Houston, Texas. She is the lead tech of the cardiac MRI department and an accomplished sonographer and has been an invited guest speaker at the ASE annual meetings and at local conferences.
While you are there, learn more about sonography in the United Arab Emirates from our highlighted international sonographer, Fadia Makarem Ezzeddine, who has more than 15 years of experience in the field. She is currently in charge of the imaging division at the Imperial College London Diabetes Centre in Abu Dhabi/United Arab Emirates. Information on both can be found on the sonographer section of the ASE Website, www.asecho.org .